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I WAS FIRST LED TO REFLECT on the topic discussed in this paper by a patient I treated in Argentina, a man with an apparently empty, dead psyche.
During the sessions he was inaccessible, absent. He hardly acknowledged my presence. I failed to find any interpretative means to make myself exist in his psyche, and thereby become able to interpret, precisely, his absence, the patient simply was not there to listen to me! My only usefulness consisted in holding—in my countertransference—the anxiety of not understanding, and not existing as an analyst in the patient's psyche (but therefore being unable to modify his emptiness, his physical death).
Mario was a man of thirty who looked like an adolescent. Although he was a student of science he had serious difficulties in thinking; he lived in almost complete isolation and had never had a love affair. Sometimes he appeared contemptous and distant, at other times overwhelmed by a catastrophic anxiety (which he did not communicate), or else he looked bewildered.
The eldest of three children, he was five years old when his brother was born, and seven when his sister arrived. His parents were Polish Jews; they had emigrated before the Second World War and their three children were born after this migration.